Dr. Marisa D’Silva is yet another member of our general internal medicine faculty who’s also a talented musician and member of the Duke Medicine Orchestra. Read on to learn about her 18 years at Duke as a clinician-educator, both for the VA PRIME and the DOC clinic. We are fortunate to have Dr. D’Silva and her commitment to teaching the next generation of physicians.
How long have you been at Duke? How long have you been in the division of General Internal Medicine?
I’ve been at Duke in General Internal Medicine since joining the faculty as a clinician-educator in 1997, right after my chief resident year at the University of Chicago. I enjoy having faculty colleagues that I worked with during their Duke residency training, and whom I now consult for their sub-specialty expertise.
What are your responsibilities within the division? What does a typical day for you look like?
I have remained focused on primary care internal medicine practice, and precept in the medicine resident continuity clinics, both DOC and PRIME. I am fortunate to work in several practice locations, each with its own community of staff and patients. This allows me to see a wide range of clinical conditions and social issues, and I really appreciate that each day of my week is different. While my career has been mostly clinical, I am temporarily now also medical director of the multidisciplinary Women’s Health Clinic at the Durham VA.
Could you tell us more about your role in the DOC clinic and the VA?
What’s it like being a physician there?
Currently I am the only GIM attending who precepts at both resident clinic sites. Over my nearly 19 years in these 2 clinics there have been so many changes- in physical locations, schedules, administrative regulations, resident duties, almost every business aspect of outpatient care. Sometimes these changes have made it very challenging to find a balance between teaching medicine and efficiently providing clinical care.
What keeps me engaged and motivated is to maintain a focus on individual patient care, and one-on-one resident teaching. I love practicing the skills of taking a good history, performing a focused physical exam, discussing differential diagnosis and diagnostic strategies, and formulating a therapeutic plan, with the challenge of teaching each patient what we are recommending and why. While the idea of doctor as teacher has always been at the core of our profession, I think the increased focus on patient centered decision making and care is one of the most positive and exciting changes in practice style, and one area where general internists can make a tremendous contribution.
I also really enjoy the way that outpatient clinic precepting allows interaction with other faculty, to compare strategies and approaches, and to share clinical ideas, as well as form personal connections. This has only become more valuable over time, as a balance to the sometimes isolating effects of administrative tasks and documentation. My colleagues in the division have been a great support through my own challenges of managing career and family, and I am very grateful for that community.
What passions or hobbies do you have outside of the division?
Music! I love most kinds of music, but especially classical music. I majored in flute and piano at Oberlin Conservatory, and kept playing mostly for my own enjoyment after shifting my focus to medicine. I get to concerts as much as I can – just between Duke Performances and Carolina Performing Arts the classical concert scene here is amazing. Since the Duke Medicine Orchestra started in 2010, I have played in the flute section – I can’t express how much fun this has been, and how much I look forward to our Sunday evening rehearsals. We have grown into a full size orchestra with around 90 members, affiliated with dozens of programs across the med center, including Duke med students and MD/PhD students, lab workers as well as emeritus faculty. We give 2 public performances a year in Baldwin Auditorium on Duke’s East campus, and several other performances for medical center and other Duke events. We also do outreach performances in local retirement communities and have collaborated with local kids groups and choirs.
If you’re interested or curious, or would consider joining us, you can find details and upcoming events on http://artsandhealth.duke.edu/programs/performing-arts/duke-medicine-orchestra. Our free public concerts in Baldwin this year are Wednesday, Dec 9, 2015- 7:30pm, after the GIM holiday party!, and Sunday May 8, 2016.
Have you recently read any books, articles, blog posts or other material that would be of interest to the division?
One great thing about being a generalist is having a sense that really everything is of interest, and everything potentially applies to our practice, and to our understanding of people and what affects health, understanding, perspective. I recently re-read Blood Done Sign My Name, by Timothy Tyson, and have recommended this to colleagues. It’s a combination of memoir and local North Carolina history relevant to racism and civil rights. I follow Ta-Nehisi Coates’ blog via the Atlantic Monthly, which gives a different perspective and analysis of the ongoing, disheartening conflicts in our society. For recent fiction I’d recommend All the Light We Cannot See, by Anthony Doerr – set in WW2 France and Germany, interesting complex characters and a suspenseful story. And for anyone else raising teenagers, I recommend checking out the comic strips Zits and Foxtrot.